Research article summary (published 30 Jul 2001):

[Aortic dissection--when operative treatment, when endoluminal therapy?]

(Die Aortendissektion--Wann operieren, wann endoluminal therapieren?)

Full Abstract

GOAL: To demonstrate the Heidelberg results of the previous 2 years in patients referred for acute aortic dissection. MATERIAL AND METHODS: 93 patients referred for acute aortic dissection were treated by cardiac surgery, vascular surgery and interventional radiology according to a novel therapeutic algorithm including stent-grafts and combined open and interventional procedures and conservative medical therapy when no malperfusion syndrome was present or patients were considered prohibitive for even minor surgical procedures. Stent-graft placements were done assisted by short term cardiac arrest to facilitate correct device deployment. RESULTS: 36 patients presented with type A and the other 57 with type B dissection. 32 of the A patients were operated and 20 of the B patients, respectively. 12 patients with B dissection were treated with stent-grafts. 3 required additional interventional therapy for organ malperfusion. The mortality was 0% in these 12 patients The overall mortality rate in the A group was close to 40% mainly as a result of postoperative organ malperfusion while it was 15% in the B group. In both groups mortality was highest in the respective untreated patient subgroup (3/4 and 8/37, respectively). The main mortality factor was visceral (mesenteric or liver) ischemia. Paraplegic complications occured in neither group. In 4 patients a combined approach applying cardiac surgery of the ascending aorta and endluminal stent-graft placement for the residual B dissection was successfully performed. In one patient this was done simultaneously. DISCUSSION: Acute aortic dissection of type A with or without valve involvement, coronary artery ischemia can be treated with high technical success rates. However, remaining distal aortic dissection associated with true lumen collapse and organ malperfusion is the main causative factor for clinical failures. Successful combination of open proximal aortic surgery with endoluminal treatment of residual B dissection encourages further use of this novel approach. Acute B type dissection appears to be effectively and safely treated by endoluminal approach in selected cases. Unsolved questions of this less invasive therapeutic approach focus mainly on the design of the proximal anchoring part of the devices.

Author information

Author/s: Richter, G M (GM); Allenberg, J R (JR); Schumacher, H (H); Hansmann, J (J); Vahl, C (C); Hagl, S (S);

Affiliation: Radiologische Klinik, Abt. Radiodiagnostik, Ruprecht-Karls-Universität Heidelberg, Ruprecht-Karls-Universität, Kirschnerstrasse 1, 69120 Heidelberg.

Journal and publication information

Publication Type: Comparative Study; English Abstract; Journal Article

Journal: Der Radiologe (Radiologe), published in Germany. (Language: ger)

Reference: 2001-Aug; vol 41 (issue 8) : pp 660-7

Dates: Created 2001/09/12; Completed 2001/12/04; Revised 2006/11/15;

PMID: 11552380, status: MEDLINE (last retrieved date: 2/18/2009)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MeSH Headings (categories) shown below.

Acute Disease Adult Aneurysm, Dissecting - diagnosis; mortality; surgery Angioplasty, Balloon Aortic Aneurysm - diagnosis; mortality; surgery Blood Vessel Prosthesis Implantation Cause of Death

Female Germany - epidemiology Humans Male Middle Aged Stents Survival Analysis

Note: Bold headings indicate primary MeSH headings or qualifiers.

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